- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.99 / $617.75 / $7,689.30
| Facility | | $544.99 | $617.75 | $7,689.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.51 / $212.06 / $240.37
| Professional | | $178.51 | $212.06 | $240.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.39 / $280.33 / $339.12
| Professional | | $231.39 | $280.33 | $339.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,791.23 / $5,791.23 / $5,791.23
| Facility | | $5,791.23 | $5,791.23 | $5,791.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.74 / $269.91 / $541.77
| Professional | | $196.74 | $269.91 | $541.77 |